Utility of static pressure ratio recording during angioplasty of arteriovenous graft stenosis

Arif Asif, Anatole Besarab, Florin Gadalean, Donna Merrill, Anne E. Rismeyer, Gabriel Contreras, Baudouin Leclercq, Oliver Lenz, Jeffery Wallach, Joshua Wallach, Michael I. Levine

Research output: Contribution to journalArticle

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Abstract

Intra-access static pressure ratio (SPR) (intra-access pressure/mean arterial pressure) can be measured during angioplasty (PTA) to assess the functional importance of an arteriovenous graft (AVG) stenosis. We used SPR in 70 patients with AVGs who underwent 98 angioplasty procedures. SPR was measured during angioplasty by placing a catheter tip at mid-access. Inflow stenosis (IF) = stenosis proximal to the tip of the catheter. Outflow stenosis (OF) = stenosis distal to the tip of the catheter up to the superior vena cava-atrial junction. Post PTA, access flow (Qa) was assessed within 2 weeks. Complete data sets for both SPR and Qa were available in 83 procedures. Using a normal SPR ratio of 0.3-0.4 at mid-graft, three patterns of SPR were noted. In 63 of 83 (76%) cases SPR was elevated prior to PTA (0.71 ± 0.13 SD). PTA reduced SPR toward normal range (0.44 ± 0.12) in 53 cases (84%). In the remaining 10 (16%), SPR decreased to a low value (0.22 ± 0.03) and normalized (0.40 ±.0.11) only after PTA of a coexisting inflow stenosis. In 12 of 83 (14%) procedures, the initial SPR was low (0.18 ± 0.04) and increased toward normal (0.3 ± 0.08) following IF stenosis PTA in seven (58%) cases. For the remaining five (42%) cases SPR increased to a high value (0.70 ± 0.21) and decreased toward normal range (0.33 ± 0.07) only after OF stenosis angioplasty. In 8 of 83 (10%) procedures, initial SPR was normal (0.33 ± 0.02). Angiography revealed coexisting IF and OF stenoses. SPR remained within the normal range after PTA of these lesions (0.33 ± 0.02). Qa increased significantly in 74 of 83 (89%) procedures (before = 572 ± 201, after = 1109 ± 368 ml/min; p < 0.001). SPR measurements can assist in hemodynamic assessment of an AVG during angioplasty procedure.

Original languageEnglish
Pages (from-to)551-557
Number of pages7
JournalSeminars in Dialysis
Volume19
Issue number6
DOIs
StatePublished - Nov 1 2006

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Angioplasty
Pathologic Constriction
Transplants
Pressure
Reference Values
Catheters
Superior Vena Cava
Angiography
Arterial Pressure
Hemodynamics

ASJC Scopus subject areas

  • Nephrology

Cite this

Utility of static pressure ratio recording during angioplasty of arteriovenous graft stenosis. / Asif, Arif; Besarab, Anatole; Gadalean, Florin; Merrill, Donna; Rismeyer, Anne E.; Contreras, Gabriel; Leclercq, Baudouin; Lenz, Oliver; Wallach, Jeffery; Wallach, Joshua; Levine, Michael I.

In: Seminars in Dialysis, Vol. 19, No. 6, 01.11.2006, p. 551-557.

Research output: Contribution to journalArticle

Asif, A, Besarab, A, Gadalean, F, Merrill, D, Rismeyer, AE, Contreras, G, Leclercq, B, Lenz, O, Wallach, J, Wallach, J & Levine, MI 2006, 'Utility of static pressure ratio recording during angioplasty of arteriovenous graft stenosis', Seminars in Dialysis, vol. 19, no. 6, pp. 551-557. https://doi.org/10.1111/j.1525-139X.2006.00221.x
Asif, Arif ; Besarab, Anatole ; Gadalean, Florin ; Merrill, Donna ; Rismeyer, Anne E. ; Contreras, Gabriel ; Leclercq, Baudouin ; Lenz, Oliver ; Wallach, Jeffery ; Wallach, Joshua ; Levine, Michael I. / Utility of static pressure ratio recording during angioplasty of arteriovenous graft stenosis. In: Seminars in Dialysis. 2006 ; Vol. 19, No. 6. pp. 551-557.
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AU - Besarab, Anatole

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AU - Rismeyer, Anne E.

AU - Contreras, Gabriel

AU - Leclercq, Baudouin

AU - Lenz, Oliver

AU - Wallach, Jeffery

AU - Wallach, Joshua

AU - Levine, Michael I.

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N2 - Intra-access static pressure ratio (SPR) (intra-access pressure/mean arterial pressure) can be measured during angioplasty (PTA) to assess the functional importance of an arteriovenous graft (AVG) stenosis. We used SPR in 70 patients with AVGs who underwent 98 angioplasty procedures. SPR was measured during angioplasty by placing a catheter tip at mid-access. Inflow stenosis (IF) = stenosis proximal to the tip of the catheter. Outflow stenosis (OF) = stenosis distal to the tip of the catheter up to the superior vena cava-atrial junction. Post PTA, access flow (Qa) was assessed within 2 weeks. Complete data sets for both SPR and Qa were available in 83 procedures. Using a normal SPR ratio of 0.3-0.4 at mid-graft, three patterns of SPR were noted. In 63 of 83 (76%) cases SPR was elevated prior to PTA (0.71 ± 0.13 SD). PTA reduced SPR toward normal range (0.44 ± 0.12) in 53 cases (84%). In the remaining 10 (16%), SPR decreased to a low value (0.22 ± 0.03) and normalized (0.40 ±.0.11) only after PTA of a coexisting inflow stenosis. In 12 of 83 (14%) procedures, the initial SPR was low (0.18 ± 0.04) and increased toward normal (0.3 ± 0.08) following IF stenosis PTA in seven (58%) cases. For the remaining five (42%) cases SPR increased to a high value (0.70 ± 0.21) and decreased toward normal range (0.33 ± 0.07) only after OF stenosis angioplasty. In 8 of 83 (10%) procedures, initial SPR was normal (0.33 ± 0.02). Angiography revealed coexisting IF and OF stenoses. SPR remained within the normal range after PTA of these lesions (0.33 ± 0.02). Qa increased significantly in 74 of 83 (89%) procedures (before = 572 ± 201, after = 1109 ± 368 ml/min; p < 0.001). SPR measurements can assist in hemodynamic assessment of an AVG during angioplasty procedure.

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